Prostate Cancer Screening May Not Be Needed in Older Men

They will often die of some other cause, study suggests

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WEDNESDAY, May 3, 2006 (HealthDay News) -- Elderly men may not benefit from aggressive treatment for prostate cancer, a new study suggests.

Even though prostate cancer can eventually be fatal, it often progresses so slowly that many men -- particularly those over 75 -- are more likely to die from some other disease. And aggressive treatments such as radical prostatectomy or radiation, while eradicating the cancer, can have negative effects on quality of life, including urinary incontinence and impotence.

As a result, aggressive therapy's side effects may not be worthwhile for elderly patients, the researchers said.

"This raises the question: Should we be aggressively looking for prostate cancer in these older men? The answer, I think, is no," said lead researcher Dr. Richard M. Hoffman, an associate professor of medicine at the University of New Mexico Cancer Research and Treatment Center.

There's no evidence there is going to be a significant survival benefit from treatment, Hoffman added. "But we are going to cause complications that are going to affect quality of life," he said.

Conservative treatments -- such as hormone therapy or so-called "watchful waiting" -- may preserve quality of life, but might not be appropriate for aggressive cancer that progresses quickly. Current guidelines suggest that men aged 75 or older may not benefit from screening. But many older men continue to be screened.

For this population-based study, Hoffman and his colleagues followed 465 men aged 75 to 84 who had been diagnosed with localized prostate cancer in 1994 or 1995. One hundred seventy-five men underwent aggressive treatment such as surgery or radiation therapy, while 290 received hormone therapy or no treatment.

The researchers then looked at health-related quality of life and survival two and seven years after the diagnosis.

"Men who received aggressive treatment for prostate cancer were much more likely to have problems with urinary incontinence and sexual dysfunction, compared with men who received watchful waiting or hormone treatment," Hoffman said.

Fewer of the men who got aggressive treatment died from the disease, Hoffman said, "but that wasn't statistically significant. Most of the men died from other causes."

The findings appear in the May issue of The American Journal of Medicine.

Hoffman said screening and treatment for prostate cancer may be worthwhile for healthy older men who have a life expectancy of 10 to 15 years. "But it's not proven," he said. "People need to understand that if they start down the pathway of looking for prostate cancer, it can lead to aggressive treatment that can cause complications that will negatively affect their quality of life."

Dr. Anthony D'Amico, chief of radiation oncology at Brigham and Women's Hospital, in Boston, said deciding who these study results apply to isn't so simple. "It depends on what kind of man over 75 with what kind of prostate cancer," he said.

Men over 75 who have non-aggressive prostate cancer will often die from something other than prostate cancer, D'Amico said. "But if you have aggressive prostate cancer, I don't think these results apply."

Older men in bad health probably don't need to be treated for prostate cancer if it's non-aggressive, D'Amico said.

Dr. Durado Brooks, director of prostate and colorectal cancers at the American Cancer Society, thinks this study underscores the problem of what to do for older men with prostate cancer.

"It raises the question about the value of screening related to the value of treatment," he said.

Another expert thinks healthy older men with aggressive prostate cancer who have a life expectancy of 10 to 15 years should be given the option of aggressive treatment.

"If these patients are willing to accept the potential side effects, the risk of dying from prostate cancer can be reduced," said Dr. Stephen Freedland, an assistant professor of urology and pathology at Duke University.

"For men 75 to 80, there are benefits and risks to treatment," Freedland said. "That's something you need to address with the patient." But treating someone over 80, Freedland agreed, is probably not productive.